Candid CIO

I shy away from openly discussing politics in my personal and professional life.  But I think it is fair to say that the current administration has abandoned what was once a significant agenda to advance health care information technology.

One could argue that the national defense issues rightly made healthcare IT less of a priority for the executive branch.  Add on top of that the recent national economic woes and I had little reason for optimism that electronic health records would surface as a top political priority for the new administration.

So, I was delighted when the president-elect recently served notice that healthcare reform remains a significant part of his plan:

“We’re also going to focus on one of the biggest long-run challenges that our budget faces, namely the rising cost of health care in both the public and private sectors. This is not just a challenge, but also an opportunity to improve the health care that Americans rely on and to bring down the costs that taxpayers, businesses and families have to pay.”

Moreover, electronic health records are a central component to his healthcare reform plan:

“If we do a smart job of investing in health care modernization — let’s just say, as an example, helping local hospitals and providers set up electronic billing and electronic medical records, that experts across the spectrum consider to be an important step towards a more efficient health care system.

Now, somebody’s got to help set those up. We’ve got to buy computer systems and so forth. That’s an immediate boost to the economy, in some cases working with state and local governments, but it’s also laying the groundwork for reducing our health care costs over the long term.”

Certainly we have a great story to tell in central and northern Wisconsin.  Ministry Health Care and Marshfield Clinic are implementing an EHR setting aside competitive interests to put patients first.  In doing so we will provide integrated care in such a way as to eliminate duplicate testing, actively manage preventive care and eliminate wasteful paper-work.  I believe we are doing exactly the kind of work that the president-elect has advocated.  I strongly support the direction he has described.

I also support president-elect Obama’s baseball affiliation.  Many of you know I am a long-time White Sox fan.  The best day of my life was the surprise 40th birthday party my wife threw for me at then Comiskey park.  So, I enjoyed this exchange between Obama and a Chicago reporter:

“I’m going to call on Steve Thomma. Where’s Steve? And the reason I’m going to call on Steve, I understand that, as a lifelong White Sox fan, you were placed in the Cubs section yesterday, and I want to apologize for that. This is also part of the new way of doing business. When we make mistakes, we admit them.”

This week a dear friend of mine passed away suddenly.  Jeanne Gittings ran the library at Trinity Regional Health System.  Jeanne and I worked together from 1995 to 2000.  A fraction of her career in the Trinity - she started in 1969 after receiving her degree from Augustana that same year.

Jeanne was dedicated to her role as a medical librarian.  It seemed more like a calling than a career.  She was selfless and constantly adopting with the times.  I got to work with Jeanne during the Internet revolution.  During that time I saw the library go from periodicals and books to PubMed and the web.

Jeanne and I taught a series of community classes on how to search for reliable medical information on the Internet.  She convinced me that I should be demonstrating Google searches (at the time I was an Alta Vista user).

After leaving Trinity I found that all medical librarians seem to demonstrate the traits of service and adaptability.  At Affinity I found that Michele Matucheski and Mary Bayorgeon were from that same mold.

Appreciate your medical librarians.  I can’t think of a better way to honor Jeanne’s memory.

There are a series of applications available that I call “extract-ware”.  These applications receive an extract of your data with the promise of allowing you to have the ability to analyze and monitor your data.  They are generally dealing with a niche like productivity, quality, provider benchmarking or market share.

I am very skeptical of these systems.  My experience is that they are typically 10 times more complicated than leaders expect and are often used much less widely than expected.

These systems are sold to business leaders that do not understand the underlying data.  The sellers of these systems leave the business buyers with the impression that these extracts are simple and every hospital has the exact same data.  In the end it turns into a huge exercise.  It is left to interpret some extract specification and deal with the following:

• Data is simply not available, which requires lengthy process changes.
• Data is not clean, leaders have used fields to store different data than intended.
• Data requires significant mapping, which is a huge ongoing burden for IT.

Usually the data issues can be conquered (with a significant and unanticipated amount of time and money).  But, in my experience, these systems still tend to fail.  They simple never get the widespread adoption originally anticipated.  Users, who want the data, never use it for a variety of reasons:

• Often these systems require additional credentials.  Since users access these systems infrequently they can’t recall their password when they go to use the system - and they don’t have the time to call the help desk.
• The systems lack the level of development needed to make them intuitive and easy to use.  If any training at all is required, they will fail.
• Complicating this is that they have multiple extract-ware systems, often with different credentials behaving and looking completely different.
• Time

There are actually other bloggers here (Ministry and/or Affinity).  I love this.  I work with so many bright people with something interesting to share.  I hope they inspire others to blog.

MD Leader is the blog I read most often, and am most close to.  It belongs to Pete Sanderson, MD.  He is Ministry’s CMIO.

Pete’s blog features both of his talents: healthcare IT and photography.  It is a surprising mix, but it really works.

Eric Haglund is on our IT leadership team.  His blog is called Appropriate IT.  I love his candor.

Michele Matucheski runs Affinity’s library.  She maintains a blog to update our staff and physicians regarding what is new at the library.  She also blogs to to communicate CME opportunities to the clinicians in our community, a great solution for reaching a lot of people outside of our network.  Michele also has a knitting and crafts blog which I do not visit as often.

Today, Governor Doyle announced our plans to create the largest patient database in the state of Wisconsin.  We appreciate the recognition from Madison and the inspiration we received from the governor’s e-health initiative.  Both efforts recognize that information silos are limiting quality of care and patient safety.

In April 2006 a group of key Ministry IT, Business and Clinical Leaders collaborated to develop an Electronic Health Record (EHR) vision that has served us well over the last two years as we developed our Clinical IT Strategy.

By the end of June 2006, using that vision as our foundation, we identified the need for a single Electronic Health Record to be shared across all of our Ministry Medical Group Clinics and hospitals in Central and Northern Wisconsin.  In addition to the need for a single, shared electronic health record we realized that our greatest clinical functionality gap exists in our medical groups.  We set out to find the best solution to provide us that single patient database and revolutionize how we care for patients in our clinics.

Ministry used a traditional system selection process to look at all of the established options in the market place.  Through our Request for Proposal process we developed a short list of options that included Epic, GE and a commercial product that the Marshfield Clinic was bringing to market: CattailsMD.

I was very hesitant about the notion of buying a new product, especially one that was developed by a company that has not traditionally sold software.  However, the opportunity to expand our vision for a shared patient database beyond our organization to include our largest patient care partners was too important not to consider.

I strongly believe that our selection process was very thorough.  we laid out the options to key leaders and medical staff members who challenged us to be very thorough in our analysis. A thorough selection of this magnitude requires a great deal of time.

In August 2007 I recommended to the Ministry board of Directors that we name CattailsMD as our Ministry-wide EHR vendor of choice.  I actually did not think this is where we would end, but we have been very surprised how well the CattailsMD offering has stacked up to the competition.  We are also very excited about their willingness to include Ministry as equal partners in the development of the product, even before the contract was signed.  We have identified 6 critical enhancements and developed details specifications.

However, we committed to the board a full business case.  We did not want to have the same experience as others that have had clinical IT projects that have run well over plan (schedule and cost).  I have half-jokingly reminded my team that our primary indicator of success will be CIO retention.  If I am still at Ministry at the end of this effort that means we did it properly.  The most important aspect of success is the preparation.

We spent 8 months developing detailed plans and testing the most technically challenging aspects of the project.  all of this was done in partnership with Marshfield Clinic without a committeemen to purchase their offering.  This level of collaboration would not exist with a traditional software vendor.  It is refreshing to have a partner with the same level of commitment to a mutually agreed upon definition of success.

This decision meant that over 1,000 doctors in our region of Wisconsin will share an Electronic Health Record.  They will jointly contribute to patient’s single medication, allergy, immunization and problem lists.  All patient care documentation will be accessible anywhere and immediately.  I believe that RHIOs (aka CHINS) have largely been a failure.  If we want real integration today, that is a quantum leap in patient care, it is clear to me that a shared electronic health record is the best way to accomplish this.

Of course I am the CIO at Affinity Health System as well.  They are observing Ministry’s progress as they look at their EHR options.

Today, many hospitals are extending the electronic records to their non-employed medical staff.  Ministry’s approach turns that model upside down.  Instead, we are purchasing an EHR from our physicians.

Now that this announcement is public I will have lots more to share.  It is my intention to use this forum to be very candid about our experience.  I believe part of our mission includes sharing what works and what was not ideal so others can improve their care, even our competitors.

I am so thankful for those that have made this happen.  Our planning project alone was 12,000 hours of effort.  It has been an incredible collaboration of medical group leadership, practicing physicians, senior leadership, Ministry’s project management office and IT.